Medical Emergencies (Nursing)

00:01 Welcome. My name is Diana Shenefield. Today’s topic is Medical Emergencies. And as you’re thinking about medical emergencies, we’re always prepared as nurses to intervene for emergencies, so this should be a really good review.

00:16 So, what do I need to know? What are my learning outcomes? I need to apply my knowledge of nursing procedures and psychomotor skills for emergencies. I need to be running through algorithms through my mind when there’s an emergency, one so I’m prepared, two so that I can intervene at a good time, but also so that I understand what’s going on in the process, and then intervene when they appear to be ready to go into emergency.

00:44 A lot of what we do as nurses is we want to prevent medical emergencies. We want to pick up on signs and symptoms when a patient is going into an emergency. We want to know if they’re going into shock or cardiac arrest so that we can prevent that from happening.

00:59 So a lot of our assessment and reassessment is prevention, but at times we will find ourselves in the midst of an emergency that we couldn’t prevent, and so what do I do as a nurse? So here’s one of the possible NCLEX questions you might see. What are the emergency nursing actions for a patient with a head injury due to a fall from a third-floor roof? So again, be thinking about that patient. Picture in your mind the emergency that has happened.

01:28 A, would you assess respirations, assess circulation and assess level of consciousness? B, stabilize C-spine, determine responsiveness, and begin chest compressions? C, stabilize C-spine, assess airway, and assess respirations? Or D, assess airway, assess respirations, and assess circulation? So again, be thinking through your mind, what has this patient just gone through? And if you think about CPR, we think about ABCs, but there’s something different about this patient in that they fell off of a roof. So hopefully you picked C. You want to stabilize your C-spine first, then do your ABCs, assess the airway and assess respirations. So again, read your question and understand whether there’s a head injury, neck injury, and what kind of emergency response is required. So when we talk about emergency care, there's things that you need to review, and CPR is at the top of the list. If it has been a while since you’ve been certified in CPR, you want to make sure you go back and look at your CPR. Make sure you know the ratio of compressions to respirations. Make sure you understand how to check responsiveness, where to check for pulses. Make sure you know the difference between infant, child and adult, and what your role is in each one of those.

02:50 How do you identify somebody that needs CPR? What kind of other things, risk factors do you need to look at? Are you looking at keeping the patient safe, keeping yourself safe? Then Heimlich maneuver, go back and review.

03:04 What do you do when in case of a conscious patient choking as opposed to an unconscious patient? What do you if it’s an infant? What do you do if it’s a child? What do you do if it’s an adult? What do you do if it’s an obese adult or a pregnant adult? Again, run those situations through your mind and make sure that you remember your CPR procedures.

03:24 Respiratory support. How do you put somebody in respiratory support if they maybe had a seizure? How do you position them? What kind of things are you watching for when you’re dealing with just respiratory? Maybe you have a near-drowning. Again, run those procedures through your mind. Make sure you understand your ABCs and how those fall under each one of these emergency responses. AEDs. Make sure you understand how an AED works.

03:53 Make sure you know the difference between a shockable and a non-shockable rhythm.

03:58 And if you don’t, make sure you understand why would somebody get shocked? What rhythm is it that the AED is looking for? And how do you keep yourself safe? How do you keep the patient safe, if you’re in water or if they have a lot of hair on their chest, what kinds of things are you watching for? Do you know the difference between child pads and adult pads, and making sure that you’re using the right pads? So again, go back to your CPR, go back to your CPR books and re-read that to make sure that that’s fresh in your mind. How do you care for a wound that has eviscerated or dehisced? What are your emergency procedures if that happens when you’re walking down the hall or if it happens at the patient’s bedside? What do you need to do as a nurse to keep your patient safe? What about monitoring a patient on a ventilator? What all kinds of things can go wrong on a patient on a ventilator? Do you know how to watch for tube dislodgement? How to watch for pneumonia? What kind of things am I assessing for that could be an emergency situation with a patient that has been intubated, and making sure that I understand how to assess and reassess.

05:07 So what interventions? Can I assess my patient at risk for medical emergencies? All the time, in the back of your mind, every patient, you should be thinking about what is the worst case scenario. Once you know what the worst case scenario is for each individual patient, then you’ll be more alert to watch for sudden signs and symptoms. So on NCLEX, when they’re giving you a patient, be thinking about what’s the worst case scenario and how would I know if that worst case scenario is playing through? Evaluate the treatment provided. If I’m giving oxygen, is the oxygen working the way that I intend it to work? Can I assess, can I evaluate and change my interventions according to my assessments and evaluations? Documenting patient response. Making sure that I’m documenting everything that I’m assessing and all of my interventions, so that I can go back and see what is working and what is not working. And then, notifying the primary health care provider in patient change status. This is one of the big reasons for lawsuits in the United States, is failure to respond and failure to report. Do I know when it’s the appropriate time to let the physician know? Do I know what subtle changes in the patient’s condition is required for me to call the physician? Make sure as you’re reading through your questions on NCLEX that you’re reading through clearly. One of the things you want to remember for NCLEX is most of the time notifying the physician isn’t going to be the right answer, because NCLEX wants to know what a nurse would do. But there are times when they’re looking at, “Do you know the time when you need to call the physician because of a change of status?” So make sure you’re reading through the questions carefully, and what is it asking you? Is it asking you what a nurse would do? Or is it asking you, “Do you understand and can you assess a change of status?” So in closing, most of you already know your CPR. You understand about medical emergencies, those are usually at the top of our minds. But again, go back and review and make sure you know the details so that you can safely and effectively take care of your patient in the emergency, that you can take care of your patient and hopefully prevent emergencies, but also be able to assess those when they happen and keep the patient safe and take care of the patient so that we don’t have bad outcomes.

07:38 As a reviewing for NCLEX, make sure that you remember your ABCs, make sure you’re looking at Maslow, and make sure you’re reporting any changes to your physician. Good luck on NCLEX.